Elation Health Patient Insurances API

The Patient Insurances API from Elation Health — 2 operation(s) for patient insurances.

Documentation GitHub OpenAPI

Business capability

Eligibility & Benefits Verification BC-2800.30

Operations 3

Each operation below carries the questions people ask an LLM about it and the instructions they give an agent to run it. Generated by API Evangelist overlay

GET /patient_insurances/{id}/eligibility/ Get a patient insurance's eligibility result · Get Eligibility #

Ask an LLM

“Is this patient's insurance coverage active according to the last eligibility check?”

“Can I see the latest eligibility status for a patient insurance?”

Tell an agent

Get the eligibility result for patient insurance {id}.

Show whether coverage {id} is currently eligible.

POST /patient_insurances/{id}/eligibility/ Run an insurance eligibility check · Create Eligibility #

Ask an LLM

“How do I run a real-time eligibility check on a patient's insurance?”

“Can I send the billing group's NPI when requesting an eligibility check?”

Tell an agent

Run an eligibility check on patient insurance {id}.

Check eligibility for insurance {id} under group {group_name} with NPI {group_npi}.

GET /patient_insurances/{id}/eligibility_full_report/ Get the full eligibility report · Get Eligibility Full Report #

Ask an LLM

“Where can I see the complete payer response for a patient's eligibility check?”

“Does the full eligibility report show copays and deductibles from the payer?”

Tell an agent

Get the full eligibility report for patient insurance {id}.

Pull the detailed payer eligibility response for coverage {id}.

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OpenAPI Specification

openapi: 3.2.0
info:
  title: Settings Patient Insurances API
  version: unknown
servers:
- url: https://sandbox.elationemr.com/api/2.0
security:
- sec0: []
tags:
- name: Patient Insurances
paths:
  /patient_insurances/{id}/eligibility/:
    get:
      summary: Get Eligibility
      description: ''
      operationId: get-eligibility
      parameters:
      - name: id
        in: path
        description: patient insurance ID
        required: true
        schema:
          type: integer
          format: int64
      - name: Authorization
        in: header
        required: true
        schema:
          type: string
      responses:
        '200':
          description: '200'
          content:
            application/json:
              examples:
                Result:
                  value: "// See Insurance Eligibility Object Definition\n{\n    \"eligibility_details\": {\n        \"copay\": null,\n        \"copay_ambiguous\": true,\n        \"coinsurance\": \"0\",\n        \"coinsurance_ambiguous\": false,\n        \"deductible\": \"2000\",\n        \"deductible_ambiguous\": false,\n        \"deductible_remaining\": \"1827.12\",\n        \"deductible_remaining_ambiguous\": false,\n        \"errors\": []\n    },\n    \"eligibility_check_timestamp\": \"2022-05-05T19:39:26+00:00\",\n    \"eligibility_status\": \"active\",\n    \"patient_id\": 140658474356545,\n    \"patient_insurance_id\": 130754515763059,\n    \"practice_id\": 6558432\n}"
              schema:
                type: object
                properties:
                  eligibility_details:
                    type: object
                    properties:
                      copay: {}
                      copay_ambiguous:
                        type: boolean
                        example: true
                        default: true
                      coinsurance:
                        type: string
                        example: '0'
                      coinsurance_ambiguous:
                        type: boolean
                        example: false
                        default: true
                      deductible:
                        type: string
                        example: '2000'
                      deductible_ambiguous:
                        type: boolean
                        example: false
                        default: true
                      deductible_remaining:
                        type: string
                        example: '1827.12'
                      deductible_remaining_ambiguous:
                        type: boolean
                        example: false
                        default: true
                      errors:
                        type: array
                  eligibility_check_timestamp:
                    type: string
                    example: '2022-05-05T19:39:26+00:00'
                  eligibility_status:
                    type: string
                    example: active
                  patient_id:
                    type: integer
                    example: 140658474356545
                    default: 0
                  patient_insurance_id:
                    type: integer
                    example: 130754515763059
                    default: 0
                  practice_id:
                    type: integer
                    example: 6558432
                    default: 0
        '404':
          description: '404'
          content:
            text/plain:
              examples:
                Result:
                  value: ''
      deprecated: false
      x-readme:
        code-samples:
        - language: python
          code: "import requests\nimport json\n\naccess_token = \"TyEPKw8fVGRKpCBa81ygwjCLXDNIAm\"\nauth_header = \"Bearer %s\" % (access_token)\n\nresp = requests.get(\"https://sandbox.elationemr.com/api/2.0/patient_insurances/130754515763059/eligibility/\",\n                    headers={'Authorization': auth_header})\n\nprint resp.status_code\nprint json.dumps(json.loads(resp.content), indent=2)"
        - language: curl
          code: 'curl https://sandbox.elationemr.com/api/2.0/patients/64184451073/ \

            > -H "Authorization: Bearer XaTtPYZ8Ufy04f0187fPbWFkwcADF0"'
          name: cURL
        samples-languages:
        - python
        - curl
      tags:
      - Patient Insurances
    post:
      summary: Create Eligibility
      description: ''
      operationId: create-eligibility
      parameters:
      - name: id
        in: path
        description: Patient Insurance ID
        required: true
        schema:
          type: integer
          format: int64
      - name: Authorization
        in: header
        required: true
        schema:
          type: string
      requestBody:
        content:
          application/json:
            schema:
              type: object
              properties:
                group_id:
                  type: integer
                  description: ID that matches the group record in Elation system
                  format: int32
                group_name:
                  type: string
                  description: Name of the group / organization. group_npi field is required if this is populated.
                group_npi:
                  type: string
                  description: NPI of the group / organization. group_name field is required if this is populated.
      responses:
        '201':
          description: '201'
          content:
            application/json:
              examples:
                Result:
                  value: "// See Insurance Elgibility Object Definition\n{\n    \"eligibility_details\": {\n        \"copay\": null,\n        \"copay_ambiguous\": true,\n        \"coinsurance\": \"0\",\n        \"coinsurance_ambiguous\": false,\n        \"deductible\": \"2000\",\n        \"deductible_ambiguous\": false,\n        \"deductible_remaining\": \"1827.12\",\n        \"deductible_remaining_ambiguous\": false,\n        \"errors\": []\n    },\n    \"eligibility_check_timestamp\": \"2022-05-05T19:39:26+00:00\",\n    \"eligibility_status\": \"active\",\n    \"patient_id\": 140658474356545,\n    \"patient_insurance_id\": 130754515763059,\n    \"practice_id\": 6558432\n}"
              schema:
                type: object
                properties:
                  eligibility_details:
                    type: object
                    properties:
                      copay: {}
                      copay_ambiguous:
                        type: boolean
                        example: true
                        default: true
                      coinsurance:
                        type: string
                        example: '0'
                      coinsurance_ambiguous:
                        type: boolean
                        example: false
                        default: true
                      deductible:
                        type: string
                        example: '2000'
                      deductible_ambiguous:
                        type: boolean
                        example: false
                        default: true
                      deductible_remaining:
                        type: string
                        example: '1827.12'
                      deductible_remaining_ambiguous:
                        type: boolean
                        example: false
                        default: true
                      errors:
                        type: array
                  eligibility_check_timestamp:
                    type: string
                    example: '2022-05-05T19:39:26+00:00'
                  eligibility_status:
                    type: string
                    example: active
                  patient_id:
                    type: integer
                    example: 140658474356545
                    default: 0
                  patient_insurance_id:
                    type: integer
                    example: 130754515763059
                    default: 0
                  practice_id:
                    type: integer
                    example: 6558432
                    default: 0
        '400':
          description: '400'
          content:
            text/plain:
              examples:
                Result:
                  value: ''
        '404':
          description: '404'
          content:
            text/plain:
              examples:
                Result:
                  value: ''
      deprecated: false
      x-readme:
        code-samples:
        - language: python
          code: "import requests\nimport json\n\naccess_token = \"TyEPKw8fVGRKpCBa81ygwjCLXDNIAm\"\nauth_header = \"Bearer %s\" % (access_token)\n\nresp = requests.get(\"https://sandbox.elationemr.com/api/2.0/patient_insurances/130754515763059/eligibility/\",\n                    headers={'Authorization': auth_header})\n\nprint resp.status_code\nprint json.dumps(json.loads(resp.content), indent=2)"
        - language: curl
          code: 'curl https://sandbox.elationemr.com/api/2.0/patients/64184451073/ \

            > -H "Authorization: Bearer XaTtPYZ8Ufy04f0187fPbWFkwcADF0"'
          name: cURL
        samples-languages:
        - python
        - curl
      tags:
      - Patient Insurances
  /patient_insurances/{id}/eligibility_full_report/:
    get:
      summary: Get Eligibility Full Report
      description: ''
      operationId: get-eligibility-full-report
      parameters:
      - name: id
        in: path
        description: patient insurance ID
        schema:
          type: integer
          format: int64
        required: true
      - name: Authorization
        in: header
        required: true
        schema:
          type: string
      responses:
        '200':
          description: '200'
          content:
            application/json:
              examples:
                Result:
                  value: '{}'
              schema:
                type: object
                properties: {}
        '400':
          description: '400'
          content:
            application/json:
              examples:
                Result:
                  value: '{}'
              schema:
                type: object
                properties: {}
      deprecated: false
      tags:
      - Patient Insurances
components:
  securitySchemes:
    sec0:
      type: oauth2
      flows:
        clientCredentials:
          tokenUrl: https://example.com/oauth2/token
          scopes: {}
x-readme:
  headers: []
x-readme-fauxas: true

Elation Health Patient Insurances API

Operations 3

Documentation

Specifications

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OpenAPI Specification